I wake up in the middle of the night and can't get back to sleep. What can I do?

Answers from Timothy Morgenthaler, M.D.

Waking up in the middle of the night is called sleep maintenance insomnia, and it's a common problem. Midsleep awakenings often occur during periods of stress. Over-the-counter sleep aids rarely offer significant help for this problem.

To help stay asleep through the night, try some of these strategies to relieve insomnia:

Establish a quiet, relaxing bedtime routine. For example, drink a cup of noncaffeinated tea, take a warm shower or listen to soft music.

Make your bedroom conducive to sleep. Keep light, noise and temperature at levels that are comfortable and won't disturb your rest. Don't engage in activities other than sleeping or sex in your bedroom. This will help your body know this room is for sleeping.

Put clocks in your bedroom out of sight. Clock-watching causes stress and makes it harder to go back to sleep if you wake up during the night.

Avoid caffeine after noon, and limit alcohol to 1 drink several hours before bedtime. Both caffeine and alcohol can interfere with sleep.

Get regular exercise. But keep in mind, exercising too close to bedtime may interfere with sleep.

Go to bed only when you're sleepy. If you aren't sleepy at bedtime, do something relaxing that will help you wind down.

Wake up at the same time every day. If you go to sleep later than usual, resist the urge to sleep in.

Avoid daytime napping. Napping can throw off your sleep cycle.

If you wake up and can't fall back to sleep within 20 minutes or so, get out of bed. Go to another room and read or do other quiet activities until you feel sleepy.

In some cases, insomnia is caused by a medical condition such as sleep apnea, restless legs syndrome or chronic pain or by a mental health disorder such as depression. Treatment for one of these underlying conditions may be necessary for insomnia to get better. Also, treating insomnia may help depression symptoms improve faster.

If you keep having sleep problems, talk to your doctor. To determine the cause and best treatment for insomnia, you may need to see a sleep specialist. Your doctor may prescribe medication and have you try other strategies to get your sleep pattern back on track.

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